Association between outpatient cardiac rehabilitation and all-cause mortality after cardiovascular surgery: A propensity score-matched analysis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular surgery (n=1095). Intervention: Outpatient multidisciplinary cardiac rehabilitation vs. No outpatient cardiac rehabilitation. Primary outcome: All-cause mortality (HR 0.35, 95% CI 0.14-0.85, p=.02).

Kenichi Shibata; Masataka Kameshima; Takuji Adachi; Kanako Araya; Akiko Shimada; Mototsugu Tamaki; Hideki Kitamura

doi:10.1016/j.xjon.2023.06.003

June 16, 2023JTCVS OpenOpen Access

Association between outpatient cardiac rehabilitation and all-cause mortality after cardiovascular surgery: A propensity score-matched analysis

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Key result

Outpatient cardiac rehabilitation after cardiovascular surgery is linked to ~65% lower all-cause mortality.

HR 0.35
95% CI 0.14-0.85
P=.02
n=1,095

Figures

Graphical abstract published by JTCVS Open — Graphical abstract · Published by JTCVS Open · CC BY-NC-ND

Why the study?

Cardiac rehabilitation is recommended for cardiovascular disease, but its postoperative prognostic effects after cardiovascular surgery remain incompletely understood.

Does multidisciplinary outpatient cardiac rehabilitation reduce all-cause mortality in patients who underwent elective cardiovascular surgery?

Key Points

To examine the association between multidisciplinary outpatient cardiac rehabilitation and postdischarge all-cause mortality among patients who underwent cardiovascular surgery.
Retrospective cohort study of 1095 consecutive patients who underwent elective cardiovascular surgery between April 2015 and March 2021 (mean age 68.5 ± 12.2 years; 273 participated in outpatient CR).
Propensity score matching (producing 254 balanced pairs) was performed using logistic regression across 27 baseline variables, including operative factors, physical and cognitive functions, and nutritional status.
In the propensity score-matched cohort (n = 508, 23 total deaths), outpatient cardiac rehabilitation was significantly associated with a 65% reduction in all-cause mortality (HR, 0.35; 95% CI, 0.14-0.85; P = .02).
In the unadjusted overall cohort (N = 1095, 51 total deaths), participation in outpatient cardiac rehabilitation was also associated with reduced mortality risk compared to nonparticipation (HR, 0.45; 95% CI, 0.21-0.95; P = .036).

Study Design

Type

Cohort (n=1,095)

Multicenter

No

Structured PICO

Does multidisciplinary outpatient cardiac rehabilitation reduce all-cause mortality in patients who underwent elective cardiovascular surgery?

P

Population

1,095 consecutive adult patients who underwent elective cardiovascular surgery at a single center in Japan, followed for a mean of 1,042 days to evaluate the prognostic effects of outpatient cardiac rehabilitation.

E

Exposure

Multidisciplinary outpatient cardiac rehabilitation (CR)

C

Comparator

Non-CR group

O

Outcome

All-cause mortalityhard clinical

Main Result

Hazard Ratio: 0.35 (95% CI 0.14–0.85)

p-value: p=.02

Multidisciplinary outpatient cardiac rehabilitation after elective cardiovascular surgery is associated with a significant survival benefit.

Limitations

Single-center study design limits generalizability of the findings.
The cohort consisted of homogeneous Japanese patients with relatively high physical function.
Unmeasured confounding factors such as perioperative complications (pneumonia, stroke, renal failure) and socioeconomic status were not assessed.
Small number of patients with follow-up extending beyond 3 years may reduce the accuracy of long-term survival rate estimates.
Results may not be generalizable to patients who choose not to enroll in cardiac rehabilitation programs.

Implication

May support increased post-surgical cardiac rehabilitation referrals; leaves open confirmation of mortality benefit in randomized trials.

Abstract

Objectives: Cardiac rehabilitation (CR) is a class I recommendation in the treatment guidelines for cardiovascular disease; however, its postoperative prognostic effects after surgery are not fully understood. Therefore, this study aimed to examine the effect of multidisciplinary outpatient CR on postdischarge all-cause mortality in patients who underwent cardiovascular surgery. Methods: This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between April 2015 and March 2021. Patients were categorized into CR and non-CR groups. The primary outcome measure was all-cause mortality. Propensity score-matching analysis was performed to minimize selection bias and differences in clinical characteristics. The propensity score for each patient was produced using logistic regression analysis, with the CR group and the subsequent 27 variables as the dependent and independent variables, respectively. Conclusions: Postdischarge multidisciplinary outpatient CR in patients who underwent cardiovascular surgery was associated with a substantial survival benefit, which persisted after adjusting for variables, including age, operative factors, physical and cognitive functions, and nutritional status.

Discussion

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Cite This Study

Shibata et al. (2023) conducted a cohort in Cardiovascular surgery (n=1,095). Outpatient multidisciplinary cardiac rehabilitation vs. No outpatient cardiac rehabilitation was evaluated on All-cause mortality (HR 0.35, 95% CI 0.14-0.85, p=.02). Postdischarge multidisciplinary outpatient cardiac rehabilitation after cardiovascular surgery was associated with a 65% reduction in all-cause mortality (HR 0.35) compared to non-participation.

synapsesocial.com/papers/6a2042aaa3b3c564e0df6071 https://doi.org/10.1016/j.xjon.2023.06.003

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Association between outpatient cardiac rehabilitation and all-cause mortality after cardiovascular surgery: A propensity score-matched analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between outpatient cardiac rehabilitation and all-cause mortality after cardiovascular surgery: A propensity score-matched analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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